Wee Benjamin Yi Hao, Lee Jan Hau, Mok Yee Hui, Chong Shu-Ling
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.
Ann Transl Med. 2020 Jun;8(12):768. doi: 10.21037/atm-20-148.
Clinicians face challenges in the timely diagnosis and management of pediatric sepsis. Pediatric heart rate has been incorporated into early warning systems and studied as a predictor for critical illness. We aim to review: (I) the role of heart rate in pediatric warning systems and (II) the role of heart rate variability (HRV) in adult and neonatal sepsis, with a focus on its potential applications in pediatrics. We conducted a literature search for papers published up to December 2019 on the utility of heart rate and HRV analysis in the diagnosis and management of sepsis, using four medical databases: PubMed, Google Scholar, EMBASE and Web of Science. This review demonstrates that the clinical utility of pediatric heart rate in predicting clinical deterioration is limited by the lack of consensus among warning systems, consensus-based guidelines, and evidence-based studies as to what constitutes abnormal heart rate in the pediatric age group. Current studies demonstrate that abnormal heart rate itself does not adequately discriminate children with sepsis from those without. HRV analysis provides a quick and non-invasive method of assessment and can provide more information than traditional heart rate. HRV analysis has the potential to add value in identification and prognostication of adult and neonatal sepsis. With further studies to explore its role, HRV analysis has the potential to add to current tools in the diagnosis and prognosis of pediatric sepsis.
临床医生在小儿脓毒症的及时诊断和管理上面临挑战。小儿心率已被纳入早期预警系统，并作为危重病的预测指标进行研究。我们旨在综述：（I）心率在小儿预警系统中的作用，以及（II）心率变异性（HRV）在成人和新生儿脓毒症中的作用，重点关注其在儿科的潜在应用。我们使用四个医学数据库：PubMed、谷歌学术、EMBASE和科学网，对截至2019年12月发表的关于心率和HRV分析在脓毒症诊断和管理中的效用的论文进行了文献检索。本综述表明，小儿心率在预测临床恶化方面的临床效用受到限制，因为预警系统、基于共识的指南以及循证研究之间对于小儿年龄组中何为异常心率缺乏共识。当前研究表明，异常心率本身并不能充分区分脓毒症患儿和非脓毒症患儿。HRV分析提供了一种快速且非侵入性的评估方法，并且能够提供比传统心率更多的信息。HRV分析在成人和新生儿脓毒症的识别和预后判断方面具有增加价值的潜力。随着进一步研究以探索其作用，HRV分析有可能为小儿脓毒症的诊断和预后判断增加现有工具。
